Current opinion in critical care
-
Curr Opin Crit Care · Oct 2007
ReviewBiomarkers to improve diagnostic and prognostic accuracy in systemic infections.
We review the advantages and drawbacks of biomarkers in the diagnostic and prognostic assessment of systemic infections. ⋯ If used in the proper setting, serial measurements of diagnostic biomarkers may allow treatments to be adjusted at an early stage in patients with severe infections. This may involve either intensifying treatment when infection levels stay high or avoiding unnecessary prolonged courses of antibiotics when levels rapidly decrease, thereby improving the allocation of healthcare resources.
-
Fluid (volume) therapy is an integral component in the management of critically ill patients and fluid management may influence outcome. There is much controversy, however, about the type, timing and amount of fluid therapy. Here, we discuss the evidence available to guide such choices. ⋯ Emerging evidence shows that choice, timing and amount of fluid therapy affect outcome. Future studies need to focus on these aspects of fluid therapy by means of larger, more rigorous and blinded controlled trials.
-
Curr Opin Crit Care · Oct 2007
Seven lessons from 20 years of follow-up of intensive care unit survivors.
Through a personal narrative, the authors discuss the lessons they have learned from 20 years of intensive care follow-up and rehabilitation. ⋯ The need and demand for care after critical illness is now firmly established.
-
To highlight the major advances in diagnosing and preventing catheter-related infections published in research articles published between March 2004 and May 2007. ⋯ Nowadays, multimodal programs of catheter infection prevention are efficacious. Levels of catheter-related bloodstream infection of more than one or two per 1000 catheter-days are usually only found in the intensive care unit. It is a prerequisite to evaluate the cost-effectiveness of new techniques of prevention. As catheter-related bloodstream infections become rarer, strategies limiting unnecessary removal of catheters need to be developed and tested.
-
Curr Opin Crit Care · Oct 2007
ReviewThe role of future longitudinal studies in ICU survivors: understanding determinants and pathophysiology of weakness and neuromuscular dysfunction.
The goals of this review are to discuss the pathophysiology and determinants of muscle weakness and neuromuscular dysfunction after critical illness, and to offer thoughts regarding the role of future longitudinal studies in this area. ⋯ Additional studies with improved methodology that address epidemiology and that test interventions are needed to understand and to improve neuromuscular function after critical illness.